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Health condition · Clinically reviewed

Morton's neuroma, the pebble-in-your-shoe pain with a clear treatment ladder.

A burning, "pebble under the foot" pain between the toes is common - and usually settles with the right footwear, padding and, when needed, a precise injection.

Jump to treatment
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE interventional procedures guidance and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including ultrasound-guided injection, sclerosing therapy and radiofrequency ablation.

Key facts

Morton's neuroma at a glance.

The essentials, in plain English - what it is, what it feels like, and how it's assessed and treated in the UK today.

  • What it is

    A benign thickening and fibrosis of an interdigital nerve in the forefoot, most often between the third and fourth toes.

  • Classic symptom

    Sharp, burning forefoot pain, often described as walking on a pebble or a fold in the sock.

  • Numbness

    Tingling or numbness in the affected toes is common alongside the pain.

  • Made worse by

    Tight, narrow shoes and high heels, which compress the forefoot and irritate the nerve.

  • Made better by

    Removing footwear and massaging the forefoot, which usually brings quick relief.

  • First-line care

    Wider shoes, a metatarsal pad and activity changes help most people before injections are considered.

Why this guide matters

A stepped plan, not endless insoles.

Morton's neuroma is common, well understood and - with the right ladder - usually manageable without surgery. The three points below shape everything else on this page.

  • Footwear is the foundation

    A wide toe box and low heel remove the compression that drives the pain - change this before anything else.

  • Ultrasound confirms it quickly

    A short scan usually confirms the diagnosis and guides precise treatment, without needing an MRI in most cases.

  • Injections work well when needed

    Ultrasound-guided steroid or sclerosing injections help many people avoid surgery altogether.

How the diagnosis is made

From forefoot pain to a clear plan.

The steps a UK podiatrist, GP or orthopaedic surgeon will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Detailed symptom history

    Where the pain sits, what it feels like, and which shoes or activities bring it on or ease it.

  2. 02

    Assessing

    Clinical examination

    Palpation of the web spaces to find the point of maximum tenderness, usually the third web space.

  3. 03

    Assessing

    Mulder's click test

    Squeezing the forefoot while pressing the web space from below can reproduce a painful click - a classic sign.

  4. 04

    Confirming

    Ultrasound imaging

    The first-line scan for a suspected neuroma - quick, well-tolerated and good at confirming size and site.

  5. 05

    Confirming

    MRI for diagnostic uncertainty

    Reserved for atypical presentations or when ultrasound findings do not match the clinical picture.

  6. 06

    Planning

    Ruling out other causes

    Stress fracture, metatarsophalangeal joint synovitis and arthritis can mimic a neuroma and are considered alongside it.

  7. 07

    Planning

    Agreeing a treatment plan

    A stepped plan from footwear and padding through injections to surgery, tailored to severity and how long symptoms have lasted.

Typical timeline: a first visit to a settled plan in a single appointment for most people.

Symptoms

What Morton's neuroma actually feels like.

The classic mix of burning pain and numbness between the toes. And the features that mean it's time to get it checked properly.

  • Sharp, burning pain

    A hot, burning ache across the ball of the foot, usually between the third and fourth toes.

  • "Walking on a pebble"

    The hallmark description - a persistent sensation of something bunched under the forefoot.

  • Numbness and tingling

    Pins and needles or reduced sensation in the toes either side of the affected nerve.

  • Worse in tight or narrow shoes

    Narrow toe boxes and high heels squeeze the metatarsal heads together and aggravate the nerve.

  • Better with rest and massage

    Taking shoes off and rubbing the forefoot typically brings rapid, if temporary, relief.

  • Web space tenderness

    Firm pressure between the toes reproduces the pain and helps localise the affected nerve.

  • Click on Mulder's test

    A palpable, often audible click when the forefoot is compressed - a reliable clinical sign.

  • Red flag - spreading or persistent numbness

    Numbness that spreads or does not settle deserves reassessment to exclude other causes.

Treatment

How Morton's neuroma is treated in the UK.

Footwear and padding first, ultrasound-guided injections next - and surgery reserved for those who don't settle with conservative care.

  • Footwear modification

    A wide toe box and low heel take pressure off the metatarsal heads and are the first thing to change.

  • Metatarsal pad or orthotics

    A pad placed just behind the metatarsal heads spreads the bones and eases nerve compression.

  • Activity modification

    Reducing time in aggravating footwear or high-impact activity while other measures take effect.

  • Simple analgesia

    Paracetamol or NSAIDs can help with flare-ups alongside footwear and padding changes.

  • Ultrasound-guided steroid injection

    A corticosteroid injection placed precisely around the nerve under ultrasound guidance, often very effective.

  • Alcohol sclerosing injections

    A series of dilute alcohol injections that gradually shrink and desensitise the nerve, for those who need more than steroid alone.

  • Radiofrequency ablation

    Heat delivered directly to the nerve under image guidance - a day-case option when injections have not held.

  • Surgical excision (neurectomy)

    Removal of the affected nerve segment when conservative measures have failed - effective, with a small risk of a residual stump neuroma.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, podiatrist or orthopaedic surgeon knows your foot and history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Interventional procedures guidance on radiofrequency ablation and sclerosing injection for Morton’s neuroma.

  • British Orthopaedic Foot & Ankle Society (BOFAS). Patient information on Morton’s neuroma.

  • Royal College of Podiatry. Guidance on assessment and conservative management of forefoot nerve pain.

  • European Society of Musculoskeletal Radiology. Consensus on ultrasound diagnosis of interdigital neuroma.

Red flags

When forefoot pain needs urgent attention.

Most Morton's neuroma is manageable in primary or podiatric care. These are the situations that aren't - and where a specialist opinion is needed.

  • Progressive numbness or weakness

    Spreading numbness, or any weakness in the foot, needs prompt reassessment to exclude a broader nerve problem.

  • Suspected stress fracture

    Point bony tenderness that worsens at night or with rest, rather than shoes, points away from a neuroma.

  • Diabetic neuropathy overlap

    In people with diabetes, new numbness may reflect peripheral neuropathy rather than a neuroma and needs its own assessment.

  • Signs of infection after injection

    Increasing redness, swelling, warmth or fever after an injection needs urgent review.

  • No response to repeated injections

    Failure to improve after well-placed injections should prompt a fresh look at the diagnosis, not simply repeating treatment.

  • Multiple or bilateral web spaces affected

    Symptoms in several web spaces or both feet raise the possibility of a systemic or neurological cause.

  • Signs of poor circulation

    A cold, pale or discoloured foot alongside forefoot pain needs assessment for peripheral vascular disease.

  • Persistent pain after surgery

    Ongoing burning pain after neurectomy can reflect a stump neuroma and should be discussed with the operating surgeon.

  • Sudden swelling or deformity

    Acute swelling or an obvious deformity points to a fracture or dislocation rather than a neuroma and needs same-day assessment.

Living with it

A treatable condition, with a clear ladder.

Four things that make the biggest difference day to day - the right shoes, patience with conservative care, pacing activity and knowing when to step up.

A quiet reminder

The right shoe often does more than any injection.

Small, steady changes to footwear and load - kept up for weeks - do more than an occasional heroic stretch of rest.

  1. 01 Footwear

    Choose a wide toe box

    Roomier shoes with a low heel are the single change that helps most people day to day.

  2. 02 Patience

    Give conservative care 6 to 8 weeks

    Padding and footwear changes take time to settle symptoms - judge them at weeks, not days.

  3. 03 Pacing

    Pace aggravating activity

    Build back up gradually rather than pushing through burning pain in tight shoes.

  4. 04 Escalate

    Don't struggle on for months

    If conservative measures are not enough, injections and, if needed, surgery have good success rates - ask about a referral.

Frequently asked

Everything we get asked about Morton's neuroma.

Quick answers on diagnosis, imaging, injections and surgery.

  • What is Morton's neuroma?

    A benign thickening and fibrosis of an interdigital nerve in the forefoot, most commonly between the third and fourth toes. It causes sharp, burning pain and numbness rather than a true tumour.

  • What does it feel like?

    Most people describe a burning pain in the ball of the foot, often with a sensation of walking on a pebble or a bunched sock, plus numbness or tingling in the adjacent toes.

  • How is it diagnosed?

    Mainly by clinical examination, including Mulder's click test, backed up by ultrasound imaging. Ultrasound is the usual first scan because it is quick and shows the nerve directly.

  • Do I need an MRI?

    Not routinely. MRI is reserved for cases where the diagnosis is uncertain after examination and ultrasound, or where findings do not fit the clinical picture.

  • What if injections don't work?

    If ultrasound-guided steroid injection does not give lasting relief, options include a course of alcohol sclerosing injections, radiofrequency ablation, or surgical excision of the nerve.

  • Is surgery a big procedure?

    Surgical excision (neurectomy) is typically a day-case procedure done under local or regional anaesthesia. Most people are back in supportive footwear within a couple of weeks, though the toes either side of the removed nerve stay numb.

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